Gender Differences In Diabetes Progression

According to a BMJ study, men with prediabetes who increased their physical activity levels and women with prediabetes who reduced their waist circumference had lower risks of progressing to diabetes.

Researchers found that older age and higher two-hour glucose and triglyceride levels increased the risk for progression to diabetes among men, while a family history of diabetes, hypertension at baseline and higher baseline waist circumference increased the risk for women. So men who increase their physical activity and women who lower their waist circumference may reduce some of their risk for progression from prediabetes to diabetes.

The objective was to investigate the gender-related affecting factors of prediabetes on its 10-year outcome, in a longitudinal study.

Prediabetes, which presents before diabetes, has been increasing globally, and the number of people with prediabetes worldwide is estimated to reach 472 million by the year 2025. In 2010, the prevalence of prediabetes was estimated to reach 36.2% in the USA and 50.1% in China.

Participants completed a questionnaire of demographic characteristics, personal and family medical history and lifestyle habits; researchers divided participants according to physical activity level with the lowest tertile designated “inactive” and the highest two tertiles as “active.” HbA1c, triglyceride and cholesterol levels were assessed at baseline and 10-year follow-up visits (mean follow-up, 10.8 years).

There were 334 participants with prediabetes enrolled in the final analysis. While a certain proportion of the prediabetic population progress to diabetes, the majority remain at the same level or even revert to normal glucose regulation. No gender difference was observed in the change of glucose regulation. However, results from an adjusted logistic regression analysis in males showed that physical activity was significantly associated with both elevated odds of reverting to normal glucose regulation (active vs inactive, OR 3.00, 95% CI 1.09 to 8.30) and developing diabetes (OR 0.34, 95% CI 0.13 to 0.92).

Age, baseline 2-hour glucose, triglycerides and smoking status were also risk factors significantly associated with diabetes development; while for females, waist circumference played a key role in the outcome. Every unit elevation of waist circumference was associated with lower odds of reverting to normal glucose regulation (OR, 0.94; 95% CI 0.89 to 0.98) and higher odds of progressing to diabetes (OR, 1.05; 95% CI 1.01 to 1.10). Baseline hypertension and family history of diabetes carried higher risk for developing diabetes as well.

At 10 years, 48% of participants continued to have prediabetes, 29.3% had progressed to diabetes and 22.5% reverted to normal glucose regulation. No differences were found between men and women for the change of glucose regulation.

Compared with inactive men, men who were active were more likely to return to normal glucose regulation (OR = 3; 95% CI, 1.09-8.3). For every centimeter increase in waist circumference in women, chances were lowered for return to normal glucose regulation (OR = 0.94; 95% CI, 0.89-0.98).

The risk for progression to diabetes was increased in men with older age (OR = 1.09; 95% CI, 1.03-1.16), higher triglyceride level (OR = 1.75; 95% CI, 1.24-2.49) and higher 2-hour glucose (OR = 1.64; 95% CI, 1.25-2.16). The risk was 3.29 times higher in men who smoked compared with those who did not. Compared with inactive men, men who were active had protective effects on the outcome of progression to diabetes (OR = 0.34; 95% CI, 0.13-0.92). Women had an increased risk for progression to diabetes if they had hypertension at baseline (OR = 2.38; 95% CI, 1.13-5.03), a family history of diabetes (OR = 2.74; 95% CI, 1.23-6.12) or higher baseline waist circumference (OR = 1.05; 95% CI, 1.01-1.1).

The study supports the notion that,active physical activity in males and lower waist circumference in females favor reversion from prediabetes to normal. In contrast, inactivity, current smoking, high 2-hour glucose and triglyceride level in males, and high fasting glucose level, high waist circumference, and family history of diabetes and hypertension in females, significantly promote progression from prediabetes to diabetes. Intervention towards prediabetes should therefore depend on different individuals with different risk factors.

Practice Pearls:

Part of the prediabetes population reverted to normal after 10 years.

Physical activity is important in the outcome of prediabetes in males.

Waist circumference is important in the outcome of prediabetes in females.

Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care2004;27:1047–53. doi:10.2337/diacare.27.5.1047